Feasibility of Immediate Dental Implantation During Scapular Free Flap Reconstruction of the Head and Neck

Background: The scapula free flap is an unpopular option for osseous reconstruction of the head and neck in part due to the inability to perform simultaneous ablative surgery and harvesting of the free flap. In addition, it was originally described as having minimal bone stock making dental rehabilitation with dental implants very difficult. Methods: Retrospective review from 2015 to 2025 of patients that underwent segmental resections involving the maxillofacial complex and received scapula free tissue transfer with dental implants. Contributing surgeons are affiliated with the following institutions: Northwell Health (Northwell Cancer Institute), University of Pittsburgh, Oregon Health & Science University, Washington University in St. Louis, and the Medical University of South Carolina. Results: Eighty-seven dental implants were placed in 29 patients mainly using the angular branch of the thoracodorsal artery. Fifteen patients (51.7%) had their implants placed during the initial ablative and scapular reconstruction. The median number of dental implants placed in each scapula was two, and overall implant osseointegration was 88.8% after following patients on average for 41 months. Conclusion: Our multi-institution review has demonstrated that the scapula free flap has adequate bone quantity to support immediate and delayed dental implants to provide long term success for dental rehabilitation. We recognize that the sample size in this series is relatively small; however, this series represents one of the largest in the current literature.